Prediction of Liver-Related Events Using Fibroscan in Chronic Hepatitis B Patients Showing Advanced Liver Fibrosis 英文参考文献.docVIP

PredictionofLiver-RelatedEventsUsingFibroscanin ChronicHepatitisBPatientsShowingAdvancedLiver Fibrosis SeungUpKim1,2,5.,JiHoonLee1.,DoYoungKim1,2,5,SangHoonAhn1,2,5,6,KyuSikJung1 ,Eun HeeChoi3,YoungNyunPark4,6,Kwang-HyubHan1,2,5,6,ChaeYoonChon1,2,5,JunYongPark1,2,5 * 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, 2Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea,3DepartmentofBiostatistics,YonseiUniversityCollegeofMedicine,Seoul,Korea,4DepartmentofPathology,YonseiUniversityCollegeofMedicine,Seoul,Korea, 5LiverCirrhosisClinicalResearchCenter,Seoul,Korea,6BrainKorea21ProjectofMedicalScience,Seoul,Korea Abstract Background: Liver stiffness measurement (LSM) using transient elastography (FibroScanH) can assess liver fibrosis noninvasively.ThisstudyinvestigatedwhetherLSMcanpredictthedevelopmentofliver-relatedevents(LREs)inchronic hepatitisB(CHB)patientsshowinghistologicallyadvancedliverfibrosis. Methods:BetweenMarch2006andApril2010,128CHBpatientswithwhounderwentLSMandliverbiopsy(LB)before starting nucleot(s)ide analogues and showed histologically advanced fibrosis ($F3) with a high viral loads [HBV DNA $2,000IU/mL] were enrolled. All patients were followed regularly to detect LRE development, including hepatic decompensation (variceal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome)andhepatocellularcarcinoma(HCC). Results:Themeanageofthepatient(72men,56women)was52.2years.Duringthemedianfollow-upperiod[median27.8 (12.6–61.6)months],LREsdevelopedin19(14.8%)patients(fivewithhepaticdecompensation,13withHCC,onewithboth). Togetherwithage,multivariateanalysisidentifiedLSMasanindependentpredictorofLREdevelopment[P,0.044;hazard ratio(HR),1.038;95%confidenceinterval(CI),1.002–1.081].Whenthestudypopulationwasstratifiedintotwogroupsusing the optimal cutoff value (19kPa), which maximized the sum of sensitivity (61.1%) and specificity (86.2%) from a time- depe